Status And Influence Factors Of Breathlessness Beliefs Of Patients With Chronic Obstructive Pulmonary Disease

Objective Dyspnea is the most common and frequently occurring symptom in patients with Chronic Obstructive Pulmonary Disease(COPD).Patients'health behavior and quality of life can be seriously affected by patients'perceptions and opinions on dyspnea symptoms and daily activities.The purpose of this study was to understand the current status of dyspnea beliefs in patients with COPD and its influencing factors,and to analyze the relationship between breathlessness beliefs and quality of life in patients with COPD based on the Fear-Avoidance Model.To provide a reference for the development of practical and feasible interventions to improve the level of breathlessness beliefs in patients with COPD in clinical work.Methods A cross-sectional survey was conducted in this study.From January to December 2018,155 patients with COPD who met the inclusion criteria were selected in the respiratory ward of a third-grade hospital in Wuhan by the convenience sampling method.The General Information Questionnaire,Modified Medical Research Council(mMRC),Chinese Breathlessness Beliefs Questionnaire(BBQ),and Connor-Davidson Resilience Scale(CD-RISC)Hospital Anxiety and Depression Scale(HAD),COPD Self-efficacy Scale(CSES)and WHO Health-related Quality of Life(WHOQOL-BREF)were administered to collect general demographic data and disease-related data,breathing difficulties,breathlessness beliefs level,psychological resilience,anxiety and depression,self-efficacy and quality of life in patients with COPD.The data were analyzed by descriptive statistical analysis,single variance analysis,bivariate correlation analysis,multiple linear regression analysis and structural equation modeling analysis.Results The breathlessness beliefs scores for patients with COPD was 37.99±4.77,the median for fear activity dimension was 22.00(20.00,23.00),and the median for fear dyspnea dimension was 17.00(15.00,19.00).There were statistically significant difference in breathlessness beliefs scores among COPD patients in different educational level,place of residence,monthly income per capita,medical insurance,degree of dyspnea,stage of disease,course of illness and frequency of hospitalization in the recent 2 years(P<0.05).The results of correlation analysis showed that there was a significant negative correlation between breathlessness beliefs score and psychological resilience score and self-efficacy score(P<0.05),which was positively correlated with mMRC score,disease staging,course of illness,frequency of hospitalization in recent 2years,anxiety and depression scores(P<0.05).The results of multivariate regression analysis showed that psychological resilience,dyspnea,anxiety,COPD self-efficacy,disease staging and residence were the influencing factors of breathlessness beliefs scores(R~2=0.599,F=39.04,P<0.001);disease staging,depression,dyspnea,self-efficacy,breathlessness beliefs,residence and course of disease were the influencing factors of quality of life scores(R~2=0.579,F=31.03,P<0.001).The analysis of structural equation model showed that psychological resilience,anxiety,dyspnea,self-efficacy and disease staging were the direct influencing factors of breathlessness beliefs scores in COPD patients;Disease staging,breathlessness beliefs,depression,self-efficacy,degree of dyspnea,anxiety and course of disease were the direct influencing factors of quality of life scores in COPD patients.Conclusion The breathlessness beliefs in patients with COPD is above the moderate level,that is,patients have negative perceptions and opinions on dyspnea symptoms and daily activities.The degree of education,stage of disease,degree of dyspnea,anxiety,psychological resilience and self-efficacy are the main influencing factors of breathlessness beliefs in patients with COPD.The breathlessness beliefs in COPD patients has a significant impact on the quality of life,that is,the quality of life of patients with COPD will be affected by patients'perceptions and opinions on dyspnea symptoms and daily activities.What's more,Fear-avoidance model can be better applied to the study of dyspnea symptoms in patients among COPD,and can be applied in nursing practice and scientific research work in the future.